Sagging of the skin on the eyelids occurs mainly in older people. However, it can also affect relatively young people, e.g. when the skin has been stressed through over-exposure to the sun, or lack of sleep. It can affect both the upper and lower eyelids. Sagging of the upper eyelid causes hooded eyelids, while sagging of the lower lid is often referred to as "bags under the eyes". The latter are caused by orbital fat entering the area underneath the skin of the eyelid. Sagging eyelids not only have a negative impact on appearance, but they can also cause an irritating sensation in some cases, or they can even cause narrowing of the field of vision. The changes can be resolved during an eyelid operation. In certain cases, the lower eyelids can also be treated with lasers. Surgical procedure for eyelid tightening / eyelid lift: a local anaesthetic injection is generally used for an eyelid operation.
Smokers should refrain from smoking for several weeks before and after the operation, as this interferes with wound healing. Anticoagulant medication such as Aspirin® or Marcumar® must also be stopped in consultation with the team of doctors.
Upper Eyelid Surgery (Upper Eyelid Blepharoplasty)
To begin with, the surgeon draws an incision line on the skin of the eyelid to prepare for the removal of excess tissue. An incision is made in the eyelid crease, or in the same direction as the crease, and the appropriate amount of tissue is removed. In some cases, the eyelid muscles and the muscles that pull the eyebrows downwards are separated and/or detached. These muscles can then be attached to the lining of the orbital bone (periosteum) in order to maintain the position of the eyebrow. This procedure is known as a "browpexy".
Lower Eyelid Surgery (Lower Eyelid Blepharoplasty) - External
A horizontal incision is made through the skin and eyelid muscles if there is a lot of sagging skin. Excess fat and skin is removed, and the muscle is attached to the periosteum.
Lower Eyelid Surgery (Lower Eyelid Blepharoplasty) - Internal
If there are bags under the eyes, excess fatty tissue can be removed from below (towards the nose). However, this only works if there is no excess sagging of the tissue. This method is carried out using incisions or laser technology. In the process, the fatty tissue can be pulled into the dark circles under the eyes, making them disappear. In this case, excess loose skin is detached but the muscle is left intact to avoid creating a protruding eyelid and a bulging eye.
Additional Tightening of the Eyelid Rim (Canthopexy)
In cases of extreme sagging skin on the lower lid, it is sometimes necessary to tighten the eyelid rim, or to fortify the outer corners of the eyelid. The muscle is attached to the outer layer of orbital bone (periosteum) around the eye socket. After the relevant procedure has been performed, the incision is sewn up using a thin suture material. To reinforce the effect, a temporary suture may sometimes be applied between the upper and lower eyelids, possibly with an additional upward suture. Plasters are also often applied to pull and affix the skin.
The eyelid should be kept cool to prevent swelling in the operation area. The client should take care to avoid excessive head movements. In the initial period after the operation, exposure to strong sunlight should be avoided in order to prevent pigmentation. Eyelid tightening is frequently performed on an outpatient basis. The client should arrange to be collected after an outpatient procedure. The patient may not drive a vehicle, operate machinery or make any critical decisions for 24 hours
The procedure often causes haematoma and swelling, but it is rarely painful. These side effects almost always disappear within days or weeks. Bleeding and secondary bleeding may occur, sometimes underneath the skin. An additional surgical procedure may be required to stop the bleeding, or to drain the blood. A feeling of tension may sometimes remain. Injuries to the eyes are very rare in eyelid operations, but cannot be completely excluded. Infections and inflammations, wound healing disorders, excessive scarring and nerve damage with a feeling of numbness may also occur. Tension or nerve damage may cause an eyelid to turn outwards or inwards, or may prevent the eyelid from fully closing. It is not always possible to prevent adverse functional or cosmetic effects. Allergic reactions of varying degrees of severity are also possible.